MS Chapter 38 Women Reproductive

dyspareunia

painful intercourse

Dysmenorrhea

painful menstruation

luteal phase of ovarian cycle

period of corpus luteum activity (days 14-28) 2nd phase

oligomenorrhea

scanty or infrequent menstrual flow Menses that occur at intervals of 45 days or longer. Cause often involves hypothalamus, pituitary gland, or ovarian function.

hysterectomy

surgical removal of the uterus

lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

menarche

the first menstrual period

stress incontinence

the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing

myomectomy

the surgical removal of uterine fibroids

menopause

the time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines

A patient has entered the hospital for a hysterectomy. A hysterectomy consists of the removal of which structure?

the uterus The removal of the uterus is referred to as a hysterectomy. The removal of the fallopian tubes is called a salpingectomy. Malignant tissue on the cervix is removed by excision. A vulvectomy is the removal of the labia, clitoris, and perineal structure.

Dysfunction uterine bleeding:

uterine bleeding that occurs at times other than the normal menstrual cycle or abnormal bleeding during menstruation.

A 53-year-old patient confides in the nurse that she has started experiencing dyspareunia and asks, "Is there anything I can do about this?" What is the nurse's best response?

"Water-soluble vaginal lubricants may provide relief." Loss of lubrication with resulting discomfort in intercourse (dyspareunia) is a symptom of estrogen deficiency, which is a normal part of the perimenopausal or postmenopausal time. Dyspareunia may be part of the aging process, but a lubricant can be used to alleviate it. Dyspareunia does not indicate an STI. It is caused by loss of lubrication with the decrease in estrogen. Scar tissue problems would have occurred earlier.

A patient states, "My periods have become further apart, but my primary care provider doesn't take it seriously." What is the nurse's best response?

"You should keep a daily record of the occurrence and severity of your symptoms for three months." Assessment of symptom charting from at least three months is necessary to make an accurate diagnosis of oligomenorrhea. The statement "Men are not usually sympathetic to menstrual concerns" is inaccurate and will not help the patient with the present problem. It is not appropriate for the nurse to recommend another provider. Reminding the health care provider each visit will not necessarily assist in making a diagnosis. The nurse should not advise the patient to self-medicate, even with over-the-counter medications. This is not a therapeutic response.

A nonpregnant patient seen in the women's clinic asks the nurse how big her uterus is. How does the nurse respond?

"Your uterus is about the size and shape of a pear." The nonpregnant uterus is about 7.5 × 5 × 2.5 cm, which is close to the size and shape of a pear. The uterus is larger at the upper end and tapers down. An orange may be the appropriate size, but it is not the appropriate shape. A cantaloupe would be too large and the wrong shape for the uterus. A grapefruit is too large and the wrong shape for the nonpregnant uterus.

Which is a change that often occurs in the postmenopausal female?

-Vaginal Dryness -Genital Atrophy -Decreased Bone Mass Vaginal dryness often occurs as a result of decreased estrogen production. Decreased bone mass is also a result of the decreased estrogen, leading to risk of osteoporosis in the postmenopausal female. The reduction in estrogen and increase in androgen is associated with genital atrophy and breast atrophy. Rather than an increase in estrogen, there is a decrease. The changes in vaginal secretions, body image, and sexual response often lead to diminished sexuality. The androgen level increases.

A patient who has premenstrual syndrome (PMS) is likely to complain of which of these symptoms several days preceding menstruation?

A bloated feeling PMS, also known as ovarian cycle syndrome, is the presence of physical, psychological, or behavioral symptoms that regularly recur within the luteal phase of the menstrual cycle and significantly disappear during the remainder of the cycle. These signs and symptoms—which occur between ovulation and menstruation—include weight gain, bloating, irritability, changes in eating patterns, fatigue, mood swings, and fear of losing control of emotions. Urinary frequency, vaginal itching, and a burst of energy are not associated with premenstrual syndrome.

There are several types of diagnostic biopsies. Which biopsy is a surgical procedure used to remove cancerous tissue?

Cone Biopsy A cone biopsy is used when a large amount of cervical tissue needs to be removed, most often when removing cancerous tissue rather than diagnosing cancer. General anesthesia is necessary to ensure comfort and minimize pain during the procedure. Colposcopy, endometrial biopsy, and cervical biopsy may be used to collect smaller specimens for assessment of the endometrium, to diagnose uterine bleeding patterns, and to diagnose cancer.

The 60-year-old female patient states to the nurse, "As I've gotten older, I just don't enjoy sex anymore because it's more painful than it used to be." The nurse should use which term to chart this patient's experience?

Dyspareunia Dyspareunia is the term used to describe painful sexual intercourse. Although age-related changes predispose the patient to dyspareunia, it should not be seen as normal; it should be treated. Pruritus (dryness and itching in the vaginal area) and vulvovaginitis do not describe painful sexual intercourse.

During which phase of the menstrual cycle does the ovum begin to mature?

Follicular During the follicular phase, a single follicle matures fully under the stimulation of follicle-stimulating hormone (FSH). An ovum does not begin to mature in the proliferative, luteal, or ischemic phases.

Before a patient's pelvic examination, the LPN/LVN should take which action?

Have the patient empty her bladder completely. The patient should be instructed to empty the bladder before a Pap smear. This will reduce discomfort during the procedure. Detergents are not used before a Pap smear. A catheterized urine specimen is not obtained before a Pap smear. There are no serious consequences or side effects related to a Pap smear.

Which statement is true regarding primary dysmenorrhea?

It may be caused by excessive endometrial prostaglandin. Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. It is not experienced by all women. Oral contraceptives can be a treatment choice. Primary dysmenorrhea occurs just before the start of monthly menses.

effleurage

Light, continuous-stroking massage movement applied with fingers and palms in a slow and rhythmic manner.

A patient describes symptoms of intermittent and irregular spotting. Which uterine bleeding disorder most likely matches the patient's symptoms?

Metrorrhagia Metrorrhagia is characterized by regular or intermittent spotting at various times in the menstrual cycle. Salpingitis is infection of the fallopian tubes. Amenorrhea is the absence of menstruation. Menorrhagia is profuse or prolonged bleeding during menstruation.

The nurse is counseling a patient with a 28-day menstrual cycle who is trying to get pregnant. The best advice for conception would be to have unprotected sex how often?

On the 14th day of her cycle Ovulation (maturation and release of an ovum) occurs midcycle, which would be around the 14th day in a 28-day cycle. Having intercourse daily may diminish the sperm count, decreasing the possibility of conception. Immediately after menstruation is considered an unlikely time for conception as the endometrium is regenerating. Five days before the menstrual period is unlikely for conception because the ova are unlikely to be fertilized.

A patient is using the basal body temperature method to avoid pregnancy. During which period should the patient abstain from intercourse?

Three to five days after the temperature rises The basal body temperature is measured and charted daily on awakening. Coitus is avoided on the day of temperature rise and for 3 to 5 subsequent days. It would not be possible to determine the timing of 2 days before a rise in temperature. It is an increase, not a decrease, in basal body temperature that signifies ovulation.

The patient presents to the clinic for her annual well-woman examination and asks for information on the purpose of a Pap smear. The nurse should base her response on which understanding of the purpose of a pap smear?

To detect abnormal cells The Pap smear is used to assess for the presence of abnormal cells of the cervix. It does not confirm pregnancy, identify microorganisms present, or determine the presence of sexually transmitted disease.

Cystocele and Rectocele

Tx -Kegel exercise, pelvic floor training, behavior -Pressary -Surgery: Mesh augmentation

sentinel node biopsy

a biopsy of the first lymph node to come into contact with cancer cells as they leave the organ of origination and start spreading into the rest of the body

menses

menstruation

mittelschmerz

abdominal pain that occurs midway between the menstrual periods at ovulation

Dowager's hump

abnormal curvature in the upper thoracic spine

amenorrhea

absence of menstruation

anovulation

absence of ovulation

climacteric

midlife transition in which fertility declines

fibroids

benign tumors in the uterus

metrorrhagia

bleeding from the uterus at any time other than normal menstruation

prolapse

descent of the uterus down the vaginal canal

polycystic ovarian syndrome

endocrine disorder associated with chronic anovulation

endometriosis

endometrial tissue located outside the uterus

hirsutism

excessive hair growth

menorrhagia

excessive menstrual bleeding

kegels

exercises are good to increase muscle tone because of the atrophy it can cause.

rectocele

hernia of the rectum

cystocele

hernia of the urinary bladder

A patient with breast cancer is being treated with tamoxifen citrate, which deprives cancer cells of the estrogen that makes them grow. This is an example of which type of therapy?

hormonal therapy This type of therapy affects hormone function. Tamoxifen blocks estrogen by binding with the estrogen receptors. This drug is usually prescribed for 5 years. Tamoxifen citrate is not considered radiation therapy, cytotoxic chemotherapy, or biologic response modifier therapy.

enterocele

intestinal hernia

pruritus

itching